2017 Sec 1 Green Book

S. Dermody et al. / International Journal of Pediatric Otorhinolaryngology 89 (2016) 121 e 126

Only and Autopsy Only ” in order to prevent the inclusion of pa- tients who would skew the disease speci fi c survival calculations. Data was then combined for each of the pediatric thyroid subtypes and standard error of the mean and 95% con fi dence intervals were calculated. Disease speci fi c survival data points at each study in- terval were compared using T-Test analysis to determine signi fi cant difference between the treatment groups. 2.3.2. Statistical analysis calculations Statistical analysis was performed utilizing the Minitab Inc. software (State College, PA) to determine statistical differences between treatment groups. Fifteen-Year Disease Speci fi c Survival data was compared utilizing the Student's T test to determine bene fi t of each treatment modality. The log rank test was not uti- lized for statistical comparison because the disease speci fi c survival curves do not re fl ect a patient's full life span from the point of diagnosis, but rather illustrate survivorship at fi fteen years from the time of initial diagnosis. The disease speci fi c survival calculations were weighted similarly to prevent bias of survivorship within the earlier or later time periods. Calculations were considered statis- tically signi fi cant if P-values were less than 0.05 and 95% con fi - dence intervals did not overlap between the two groups of interest. A total of 1723 pediatric patients were located in the SEER Database and further strati fi ed based on age, sex, and ethnicity. According to our analysis, teenage Caucasian females maintained the highest frequency of obtaining a diagnosis of thyroid carcinoma when evaluating rates per 100,000 patients. Furthermore, females maintained an age-adjusted rate of diagnosis compared to males of approximately 4.4:1 per 100,000 patients. Lastly, African Americans and the unspeci fi ed cohorts demonstrated less frequent diagnoses across each age group when compared to the Caucasian cohort ( Table 1 ). The overall age adjusted average rate of pediatric thyroid cancer from 2007 to 2012 was determined to be 0.59 new diagnoses per 100,000 individuals (see Table 2 ). When evaluating papillary thy- roid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma, and papillary follicular carcinoma thyroid subtypes, the average rates of incidence were determined to be: 0.30 (47.6%), 0.14 (23.8%), 0.05 (6.7%), and 0.13 (21.9%) per 100,000 reported patients, regardless of age, respectively. Furthermore, papillary, follicular, and papillary follicular variant became more prominent in terms of frequency of diagnosis as pediatric patients reached the fi fteen to nineteen age groups ( Fig. 1 ). Medullary thyroid cancer was the most frequent in terms of incidence in the zero to four years of age group, Table 1 Demographics of pediatric patients diagnosed with papillary thyroid cancer as rate per 100,000 patients from 2007 to 2012. Age group 1 e 4 5 e 9 10 e 14 15 e 19 Sex Male 0.001 0.04 0.11 0.31 Female 0.01 0.05 0.36 1.48 3.2. Average age adjusted incidence rate of pediatric thyroid cancer subtypes 3. Results 3.1. Patient cohort demographics

Table 2 Demographics of pediatric patients diagnosed with thyroid cancer. Carcinoma subtype Diagnosis count

Frequency of total

Papillary

1014

58.8 23.0 10.1

Papillary follicular variant

397 173 139

Follicular Medullary

8.1

Fig. 1. Incidence of pediatric thyroid carcinoma based on most frequent subtype per 100,000 as a percent of total cohort. (For interpretation of the references to colour in this fi gure legend, the reader is referred to the web version of this article.)

but subsequently declined once the fi ve to nineteen years of age group demographics were analyzed ( Fig. 1 ).

3.3. Overall fi fteen year disease speci fi c survival of individuals diagnosed with pediatric thyroid cancer

At fi fteen years post diagnosis, the disease speci fi c survival for each age group, regardless of tumor subtype, demonstrated greater than ninety percent survival. Speci fi cally, the younger de- mographics, including the zero to four and fi ve to nine years of age groups, maintained a fi fteen-year disease speci fi c survival of approximately ninety-nine percent when surgery and radiation therapy, radioactive iodine uptake or external beam therapy, were utilized. Interestingly, patients who were diagnosed in the ten to fourteen and fi fteen to nineteen age groups maintained excellent survival outcomes, yet fi fteen-year disease speci fi c survival were signi fi cantly lower compared to the two younger age groups (p < 0.05). Despite this statistically signi fi cant difference, the two older cohorts still demonstrated a disease speci fi c survival greater than 95% ( Fig. 2 ).

3.4. Fifteen year disease speci fi c survival based on cancer subtype and therapeutic intervention

Pediatric patients, regardless of age group, demonstrated excellent fi fteen-year disease speci fi c survival after intervention with surgery or surgery with adjuvant radiation, radioactive iodine uptake or external beam therapy. Individuals demonstrated signif- icantly improved survival outcomes if they underwent radiation therapy in conjunction with their primary surgery management regardless of tumor subtype (p < 0.001). The fi fteen-year disease

Ethnicity

Caucasian

0.01

0.08

0.38

0.27 0.08 0.19

African American 0.00

0.007 0.03

Unspeci fi ed

0.001 0.003 0.05

167